[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3039 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 3039
To amend title XI of the Social Security Act to establish an
interagency council on social determinants of health, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 21, 2021
Mr. Young (for himself and Ms. Stabenow) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to establish an
interagency council on social determinants of health, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Social Determinants Accelerator Act
of 2021''.
SEC. 2. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.
Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is
amended by adding at the end the following new part:
``PART E--SOCIAL DETERMINANTS OF HEALTH
``social determinants accelerator council
``Sec. 1191. (a) Establishment.--The Secretary, in consultation
with the Administrator of the Centers for Medicare & Medicaid Services,
the Administrator of the Health Resources and Services Administration,
the Director of the Centers for Disease Control and Prevention, the
Director of the Agency for Healthcare Research and Quality, and the
Director of the Indian Health Service, shall establish an interagency
council, to be known as the Social Determinants Accelerator Interagency
Council (referred to in this part as the `Council') to achieve the
purposes of--
``(1) establishing effective, coordinated Federal technical
assistance to help State and local governments to improve
outcomes and cost-effectiveness of, and return on investment
from, health and social services programs;
``(2) building a pipeline of State and locally designed,
cross-sector interventions and strategies that generate
rigorous evidence about how to improve health and social
outcomes, and increase the cost-effectiveness of, and return on
investment from, Federal, State, local, and Tribal health and
social services programs;
``(3) enlisting State and local governments and the service
providers of such governments as partners in identifying
Federal statutory, regulatory, and administrative challenges in
improving the health and social outcomes of, cost-effectiveness
of, and return on investment from, Federal spending on
individuals receiving medical assistance under a State plan (or
a waiver of such plan) under title XIX; and
``(4) developing strategies to improve health and social
outcomes without denying services to, or restricting the
eligibility of, vulnerable populations.
``(b) Membership.--
``(1) Federal members.--The Council shall be composed of at
least 1 designee from each of the following Federal agencies:
``(A) The Office of Management and Budget.
``(B) The Department of Agriculture.
``(C) The Department of Education.
``(D) The Department of Housing and Urban
Development.
``(E) The Department of Labor.
``(F) The Department of Transportation.
``(G) Any other Federal agency the Chair of the
Council determines necessary.
``(2) Designation.--
``(A) In general.--The head of each agency
specified in paragraph (1) shall designate at least 1
employee described in subparagraph (B) to serve as a
member of the Council.
``(B) Responsibilities.--An employee described in
this subparagraph shall be a senior employee of the
agency--
``(i) whose responsibilities relate to
authorities, policies, and procedures with
respect to the health and well-being of
individuals receiving medical assistance under
a State plan (or a waiver of such plan) under
title XIX; or
``(ii) who has authority to implement and
evaluate transformative initiatives that
harness data or who conducts rigorous
evaluation to improve the impact and cost-
effectiveness of federally funded services and
benefits.
``(3) HHS representation.--In addition to the designees
under paragraph (1), the Council shall include designees from
agencies within the Department of Health and Human Services,
including the Centers for Medicare & Medicaid Services, the
Agency for Healthcare Research and Quality, the Centers for
Disease Control and Prevention, the Health Resources and
Services Administration, and the Indian Health Service. The
designees of each such agency shall include at least 1 designee
who meets the criteria under paragraph (2)(B).
``(4) Non-federal members.--The Council shall include at
least 9 non-Federal members, to be designated by the Secretary,
with experience in improving the impact and cost-effectiveness
of Federal Government health and social services, of which--
``(A) at least 1 such member shall be a director of
a State or local human services agency;
``(B) at least 1 such member shall be a director of
a Tribal health authority;
``(C) at least 1 such member shall be a director of
a public housing authority or State housing finance
agency;
``(D) at least 1 such member shall be a director of
a State or local government budget office;
``(E) at least 1 such member shall be a State
Medicaid program director;
``(F) at least 1 such member shall be from a State
office of rural health;
``(G) at least 1 such member shall be a
representative from a national consumer or patient
advocacy organization;
``(H) at least 1 such member shall be a primary
care provider with clinical experience working in
medically underserved populations; and
``(I) at least 1 such member shall be a
representative from a commercial health plan.
``(5) Chair.--The Secretary shall select the Chair of the
Council from among the members of the Council.
``(c) Duties.--The duties of the Council are--
``(1) to make recommendations to the Secretary regarding
the criteria for making awards under section 1192;
``(2) to identify Federal authorities and opportunities for
use by States or local governments to improve coordination of
funding and administration of Federal programs that serve
individuals with significant unmet health and social needs, as
defined by the Secretary, and for whom coordinated health and
social interventions may be unknown or underutilized;
``(3) to make information on such authorities and
opportunities publicly available;
``(4) to provide targeted technical assistance to States
developing social determinants of health interventions;
``(5) to report to Congress annually in accordance with
subsection (e);
``(6) solicit feedback from State, local, and Tribal
governments on best practices for addressing social
determinants of health and for coordinating health and social
service programs;
``(7) to develop and disseminate such best practices;
``(8) to develop and disseminate performance measures to
reliably assess the impact of local interventions or
approaches;
``(9) to coordinate with other cross-agency initiatives
focused on improving the health and well-being of low-income
and at-risk populations in order to prevent unnecessary
duplication between agency initiatives; and
``(10) to draft and make publicly available a report on
Federal cross-agency opportunities to address social
determinants of health, which shall include the benefits of
grants to State, local, or Tribal jurisdictions.
``(d) Schedule.--Not later than 90 days after the date of the
enactment of the Social Determinants Accelerator Act of 2021, the
Council shall convene to develop a schedule and plan for carrying out
the duties described in subsection (c), including solicitation of
applications for the grants under section 1192.
``(e) Report to Congress.--The Council shall submit an annual
report to Congress, which shall include--
``(1) a list of the Council members;
``(2) summaries of the activities and expenditures of the
Council;
``(3) summaries of the interventions and approaches that
will be supported by State, local, and Tribal governments that
received a grant under section 1192, including evidence-based
best practices and approaches grantees have employed to improve
health outcomes, and improve the cost-effectiveness of, and
return on investment from, Federal, State, local, and Tribal
governments;
``(4) the feedback received from State and local
governments on ways to improve the technical assistance of the
Council, and actions the Council plans to take in response to
such feedback; and
``(5) the major statutory, regulatory, and administrative
challenges identified by State, local, and Tribal governments
that received a grant under section 1192, and the actions that
Federal agencies are taking to address such challenges.
``(f) FACA Applicability.--The Federal Advisory Committee Act (5
U.S.C. App.) shall not apply to the Council.
``(g) Council Procedures.--The Secretary, in consultation with the
Comptroller General of the United States and the Director of the Office
of Management and Budget, shall establish procedures for the Council
to--
``(1) ensure that adequate resources are available to
effectively execute the responsibilities of the Council;
``(2) effectively coordinate with other relevant advisory
bodies and working groups to avoid unnecessary duplication;
``(3) create transparency to the public and Congress with
regard to Council membership, costs, and activities, including
through use of modern technology and social media to
disseminate information; and
``(4) avoid conflicts of interest that would jeopardize the
ability of the Council to make decisions and provide
recommendations.
``grants to address social determinants of health
``Sec. 1192. (a) Grants to States, Local Governments, and
Tribes.--
``The Secretary, in consultation with the Council, shall
award on a competitive basis up to 25 grants to eligible
applicants described in subsection (b) for addressing social
determinants of health in underserved populations. Not later
than 180 days after the date of the enactment of the Social
Determinants Accelerator Act of 2021, the Secretary shall award
all such grants.
``(b) Eligible Applicant.--In order to be eligible to apply for a
grant under this section, an entity shall be--
``(1) a State, local, territorial, or Tribal health agency
or organization;
``(2) a qualified nongovernmental entity, as defined by
Secretary; or
``(3) a consortium of entities that includes a State,
local, territorial, or Tribal health agency or organization.
``(c) Amount of Grant.--The Secretary, in coordination with the
Council, shall determine the total amount that the Secretary will make
available to each grantee under this section.
``(d) Application.--An eligible applicant seeking a grant under
this section shall submit an application at such time, in such manner,
and containing such information as the Secretary may require, and
submit a proposed process for developing a social determinants
accelerator plan in accordance with subsection (e).
``(e) Use of Funds.--A grant under this section shall be used--
``(1) to engage qualified research experts to advise on
research relevant to, and to design, a proposed social
determinants accelerator plan, in accordance with standards and
guidelines issued by the Secretary;
``(2) to collaborate with the Council to support the
development of a social determinants accelerator plan;
``(3) to prepare and submit a final social determinants
accelerator plan to the Secretary; and
``(4) to address social determinants of health in a target
community in a State, county, city, or other municipality, by
designing and implementing innovative, evidence-based, cross-
sector strategies to improve the health and well-being of
individuals in such community through the implementation of the
final social determinants accelerator plan.
``(f) Priority.--In awarding grants under this section, the
Secretary shall prioritize applicants proposing to serve target
communities with significant unmet health and social needs, as defined
by the Secretary.
``(g) Contents of Plans.--A social determinants accelerator plan
developed through a grant under this section shall include the
following:
``(1) A description of the population (or populations) in
the target community that would benefit from implementation of
the social determinants accelerator plan, including an analysis
describing the projected impact on the well-being of
individuals described in subsection (e)(4).
``(2) A description of the interventions or approaches
designed under the social determinants accelerator plan and the
evidence for selecting such interventions or approaches.
``(3) The objectives and outcome goals of such
interventions or approaches, including at least 1 health
outcome and at least 1 other important social outcome.
``(4) A plan for accessing and linking relevant data to
enable coordinated benefits and services for the relevant
jurisdictions and an evaluation of the proposed interventions
and approaches.
``(5) A description of the State, local, Tribal, academic,
nonprofit, or community-based organizations, or any other
private sector organizations that would participate in
implementing the proposed interventions or approaches, and the
role each would play to contribute to the success of the
proposed interventions or approaches. Such entities may
include--
``(A) health systems;
``(B) payors, including, as appropriate, medicaid
managed care entities (as defined in section
1903(m)(1)(A)), Medicare Advantage plans under part C
of title XVIII, and health insurance issuers and group
health plans (as such terms are defined in section 2791
of the Public Health Service Act);
``(C) other relevant stakeholders and initiatives
in areas of need, such as the Accountable Health
Communities Model of the Centers for Medicare &
Medicaid Services, health homes under the Medicaid
program under title XIX, community-based organizations,
and human services organizations;
``(D) other non-health care sector organizations,
including organizations focusing on transportation,
housing, or food access; and
``(E) local employers.
``(6) The identification of any supplemental funding
sources that would be used to finance the proposed
interventions or approaches.
``(7) A description of any financial incentives that may be
provided, including outcome-focused contracting approaches to
encourage service providers and other partners to improve
outcomes of, cost-effectiveness of, and return on investment
from, Federal, State, local, or Tribal government spending.
``(8) The identification of the applicable Federal, State,
local, or Tribal statutory and regulatory authorities,
including waiver authorities, to be leveraged to implement the
proposed interventions or approaches.
``(9) A description of potential considerations that would
enhance the impact, scalability, or sustainability of the
proposed interventions or approaches and the actions the grant
awardee would take to address such considerations.
``(10) A evaluation plan, to be carried out by an
independent evaluator, to measure the impact of the proposed
interventions or approaches on the outcomes of, cost-
effectiveness of, and return on investment from, Federal,
State, local, and Tribal governments.
``(11) Precautions for ensuring that vulnerable populations
will not be denied access to the Medicaid program under title
XIX or other essential services as a result of implementing the
social determinants accelerator plan.
``(h) Monitoring and Evaluation.--As a condition of receipt of a
grant under this section, a grantee shall agree to submit an annual
report to the Secretary describing the activities carried out through
the grant and the outcomes of such activities.
``(i) Independent National Evaluation.--
``(1) In general.--Not later than 3 years after the first
grants are awarded under this section, the Secretary shall
provide for the commencement of an independent national
evaluation of the program under this section.
``(2) Report to congress.--Not later than 90 days after
receiving the results of such independent national evaluation,
the Secretary shall report such results to the Congress.
``(j) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to the Secretary $10,000,000 for each of fiscal years 2022
through 2026 to carry out this section.
``(2) Reservation.--Of the funds made available to carry
out this section, the Secretary shall reserve not less than 20
percent to award grants to eligible applicants for the
development of social determinants accelerator plans under this
section intended to serve rural populations.''.
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